Caring Decisions Life Support Treatment

“Life support treatment” refers to any medical treatment that is used to keep a patient alive.

In this handbook we will use the term “life support” or “life support treatment” to refer to any medical treatment used to keep someone alive. It is important to understand that life support treatment does not treat what is making a child ill or make them better. It helps the body’s organs to keep working. Life support treatment is often helpful to let the body rest while it recovers. Sometimes life support treatment does not work, and sometimes it does more harm than good.

Here are some other terms that are used to mean the same thing

* Life-saving treatment
* Life-sustaining treatment
* Life-prolonging treatment
* Intensive medical support
* Resuscitation treatment

Yes. Life support treatment includes machines like breathing machines or kidney machines. It also can include medical or surgical procedures, and medicines.

There is a list below of some different types of life support treatment. Depending on a child’s condition it might be appropriate for them to receive none of these treatments, or some of them, or all of the treatments. See ‘Making decisions about different types of life support treatment’. Some of these treatments are very specialised and invasive and available only in an ‘intensive care unit’. Other life support treatments are simpler and might be provided in other places, including in a child’s home.

Life support treatment for children having trouble breathing
Oxygen – providing extra oxygen for example by a mask over the face or tubes in a child’s nose

Suction – using a machine and tube to remove saliva or other secretions from a child’s mouth or air passages

Artificial breathing – helping a child who is not breathing enough on their own. This can be by mouth-to-mouth (where someone breathes directly into another person’s lungs) by a breathing bag with a mask over the mouth and nose, or by a machine that blows air into the child’s lungs through a mask or tube .

Ventilator – a machine that provides artificial breathing to the child through breathing tubes (also called ‘invasive ventilation’ or ‘mechanical ventilation’)

Non-invasive ventilation(CPAP pronounced “sea-pap”or BiPAP “bye-pap”)- a machine that provides breathing support, usually requiring a tight-fitting mask to the child’s nose or face.

Airway tubes- tubes to keep a child’s air passages open. This can include a small plastic tube in the mouth or nose to the back of the throat, or a breathing tube that goes through the throat into the lungs (endotracheal tube).

Tracheostomy- breathing tube that goes through the front of the neck rather than through the nose or mouth. Requires a surgical operation to put in.

Life support treatment for children with problems with the heart or other organs
Heart massage (cardiac compressions)- pressing on the child’s chest using hands or a machine to squeeze blood around the body when the child’s heart is not pumping

Cardiopulmonary Resuscitation (CPR)- includes artificial breathing and heart massage for a child who is not breathing or whose heart has stopped

Blood pressure medicines (inotropes, pronounced “eye-no-tropes”)- strong medicines to increase a child’s blood pressure by making the heart pump harder or squeezing the body’s blood vessels tighter

Heart-lung bypass, (extra-corporeal membrane oxygenation, ECMO “Eck-mow”)- machines that can put oxygen directly into the blood or pump the blood through the body (or both). This is a highly complex treatment requiring multiple specialists, and only available in a small number of hospitals. Requires a surgical operation to insert large tubes into blood vessels in the neck, chest or legs.

Kidney machine(dialysis, haemodialysis, haemofiltration) – a machine that takes waste products out of the body and removes fluid when a child’s kidneys are not working

Artificial feeding/nutrition- giving food to a child through a tube because they are not able to eat enough by mouth. This can be through a tube in the nose (nasogastric tube), through a tube in the front of the stomach (gastrostomy or PEG tube), or directly into a vein (parenteral nutrition).

Gastrostomy (PEG) – feeding tube that passes through the skin directly into the stomach. Requires a surgical operation to put in.

Intravenous line (IV, intravenous catheter, “jelco”)- tube placed using a needle into the child’s vein to give fluids or medicines.

Central line (central venous catheter)- tube passed using a needle into one of the large veins of the body. Requires a special procedure to insert. Used to give blood pressure medicines or parenteral nutrition (feeding into a vein). (Other names include a ‘port’ or ‘CVAD – Central Venous Access Device’

Antibiotics- medicines used to fight bacterial infections

Blood transfusions(also platelets, plasma) – putting blood or other blood products into a child’s vein because they do not have enough of their own